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Prognostic factors affecting macular hole closure types.

Gülşah Gümüş1, Gökhan Demir2, Beril Tülü Aygün3

  • 1Dr. Ersin Arslan Training and Research Hospital, Eyupoglu, Hurriyet Cd. No: 40, Sahinbey, 27010 Gaziantep, Turkey.

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Summary

Preoperative horizontal measurements of macular holes, including minimum linear diameter and basal hole diameter, predict closure types after surgery. Larger diameters correlate with a higher risk of reopening, aiding in visual outcome predictions.

Keywords:
macular holemacular hole measurementsoptic coherence tomographypars plana vitrectomy

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Medical Imaging

Background:

  • Idiopathic macular holes (MH) are a common cause of visual impairment.
  • Surgical repair, typically pars plana vitrectomy with internal limiting membrane peeling, aims for anatomical closure and visual recovery.
  • Predicting surgical outcomes and potential complications remains a key challenge.

Purpose of the Study:

  • To evaluate the relationship between macular hole closure types, as assessed by optical coherence tomography (OCT), and preoperative prognostic factors.
  • To identify preoperative OCT measurements that predict different macular hole closure patterns.
  • To determine if preoperative factors can predict the likelihood of MH reopening.

Main Methods:

  • Retrospective review of 183 patients undergoing surgery for idiopathic MH.
  • Preoperative OCT measurements including minimum linear diameter (MLD), basal hole diameter (BHD), and hole height (HH) were analyzed.
  • Patients were classified into two postoperative closure types based on OCT findings; closure type 1 (complete neurosensory retina reattachment) and type 2 (partial defect).
  • Statistical analysis compared prognostic factors (age, symptom duration, BCVA, MH measurements, reopening rate) between closure types.

Main Results:

  • 117 eyes (63.9%) achieved type 1 closure, and 66 eyes (36.1%) had type 2 closure.
  • No significant differences were found in age, symptom duration, or preoperative best-corrected visual acuity (BCVA) between the groups.
  • Significantly larger MLD and BHD were observed in the type 2 closure group (p<0.05).
  • The rate of reopening was significantly higher in the type 2 closure group (p<0.005).
  • No significant difference in hole height (HH) was noted between the closure types (p=0.239).

Conclusions:

  • Preoperative horizontal macular hole measurements (MLD and BHD) are significant predictors of postoperative closure type.
  • Wider MLD and BHD are associated with type 2 closure and a higher risk of reopening.
  • These preoperative horizontal dimensions can help in determining postoperative visual expectations, anatomical success, and predicting the possibility of reopening.